{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:05:48Z","timestamp":1790010348006,"version":"4.0.1"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Middle meningeal artery (MMA) embolization (MMAE) is a new therapeutic modality for chronic subdural hematoma (cSDH). There is limited evidence comparing various MMAE procedural techniques, resulting in significant variations in technique and procedural planning. The objective of this study was to compare outcomes of MMAE by the number and location of MMA branches that were embolized.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A single-center retrospective study of patients with cSDH treated by MMAE was conducted. Clinical outcomes, need for re-intervention, and changes in hematoma size were compared between different MMAE techniques.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Ninety-four cSDHs in 78 patients were included. Embolization of the proximal trunk only, distal branches only, or proximal trunk plus distal branches resulted in similar rates of need for rescue surgery (7.4%, 13.0%, and 6.8%, respectively; p = 0.66) and rates of reducing the volume of the hematoma by at least 50% (74.1%, 80.0%, and 77.5%, respectively; p = 0.88). Embolization of only one branch had similar outcomes to embolization of more than one branch, as rescue surgery rates were 9.3% and 7.8% (p = 0.80), and rates \u2265 50% volume reduction were 75.6% and 78.3% (p = 0.76), respectively. Selective embolization of the dominant MMA branch was not associated with significantly different outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Outcomes of distal, proximal, or combined proximal and distal MMAE in cSDH are not significantly different. Embolization of more than one branch is not associated with improved treatment efficacy. Arguably, targeting any location in the MMA provides sufficient flow restriction to enable spontaneous hematoma resolution. Accordingly, a technical planning algorithm for cSDH MMAE is suggested.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.9.jns221663","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T12:19:37Z","timestamp":1668773977000},"page":"1494-1502","source":"Crossref","is-referenced-by-count":33,"title":["Middle meningeal artery embolization for treatment of chronic subdural hematomas: does selection of embolized branches affect outcomes?"],"prefix":"10.3171","volume":"138","author":[{"given":"MirHojjat","family":"Khorasanizadeh","sequence":"first","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Shutran","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Garcia","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Enriquez-Marulanda","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Moore","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajith J.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"J Neurosurg","first-page":"1209","article-title":"Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations","volume":"123","author":"Balser D","year":"2015","unstructured":"Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. 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PLoS One. 2015;10(10):e0140450."},{"issue":"4","key":"b4","series-title":"Interv Neuroradiol","first-page":"577","article-title":"Risk of recurrence of subdural hematoma after EMMA vs surgical drainage\u2014systematic review and meta-analysis","volume":"27","author":"Dian J","year":"2021","unstructured":"Dian J, Linton J, Shankar JJ. Risk of recurrence of subdural hematoma after EMMA vs surgical drainage\u2014systematic review and meta-analysis. Interv Neuroradiol. 2021;27(4):577\u2013583.33525919"},{"issue":"5","key":"b5","series-title":"J Neurosurg","first-page":"1143","article-title":"Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation","volume":"129","author":"Motiei-Langroudi R","year":"2018","unstructured":"Motiei-Langroudi R, Stippler M, Shi S,  Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation. J Neurosurg. 2018;129(5):1143\u20131150.29243977"},{"key":"b6","series-title":"Front Neurol","first-page":"557233","article-title":"Middle meningeal artery embolization for chronic subdural hematoma","volume":"11","author":"Catapano JS","year":"2020","unstructured":"Catapano JS, Nguyen CL, Wakim AA, Albuquerque FC, Ducruet AF. Middle meningeal artery embolization for chronic subdural hematoma. Front Neurol. 2020;11:557233.33192990"},{"issue":"4","key":"b7","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases","volume":"49","author":"Joyce E","year":"2020","unstructured":"Joyce E, Bounajem MT, Scoville J,  Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases. Neurosurg Focus. 2020;49(4):E5.33002874"},{"issue":"4","key":"b8","series-title":"J Neurosurg","first-page":"1208","article-title":"A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas","volume":"135","author":"Catapano JS","year":"2021","unstructured":"Catapano JS, Ducruet AF, Nguyen CL,  A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas. J Neurosurg. 2021;135(4):1208\u20131213.33636706"},{"issue":"2","key":"b9","series-title":"Neurosurgery","first-page":"268","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations","volume":"88","author":"Kan P","year":"2021","unstructured":"Kan P, Maragkos GA, Srivatsan A,  Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. 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Landmark-based analysis of the morphological relationship between endocranial shape and traces of the middle meningeal vessels. Anat Rec (Hoboken). 2009;292(4):518\u2013527.19226614"},{"issue":"1","key":"b20","series-title":"Clin Neuroradiol","first-page":"57","article-title":"Angiographic anatomy of the middle meningeal artery in relation to chronic subdural hematoma embolization","volume":"32","author":"Shotar E","year":"2022","unstructured":"Shotar E, Premat K, Lenck S,  Angiographic anatomy of the middle meningeal artery in relation to chronic subdural hematoma embolization. Clin Neuroradiol. 2022;32(1):57\u201367.33625552"},{"issue":"6","key":"b21","series-title":"J Korean Neurosurg Soc","first-page":"628","article-title":"Spontaneous resolution of chronic subdural hematoma: close observation as a treatment strategy","volume":"59","author":"Kim HC","year":"2016","unstructured":"Kim HC, Ko JH, Yoo DS, Lee SK. 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